Advocates for Disabled Decry Proposed Medicaid Cuts

House ACA repeal bill would affect home, community-based services

WASHINGTON -- Not only will disabled people be harmed by the Medicaid cuts included in the House Republicans' bill to repeal and replace the Affordable Care Act, the cuts likely won't end up saving money, several speakers said Monday at an event organized by the American Civil Liberties Union (ACLU).

The American Health Care Act that was passed by the House last month included $880 billion in cuts to Medicaid and also called for the program to be turned into a per-capita cap arrangement, in which states would receive a set amount from the federal government for each Medicaid enrollee. Per-capita cap funding would represent a "fundamental restructuring" of the Medicaid program, under which the federal government currently pays states a percentage match based on how much the state spends on its Medicaid program, said Marty Ford, senior executive officer in the public policy office at The Arc of the United States, a non-profit organization that provides services to the intellectually and developmentally disabled. There is no cap on the amount the federal government will pay in matching funds.

'This [bill] would end the federal government's guarantee of matching state spending on actual costs, and once that's gone, we feel it's unlikely we'd ever get it back," Ford said to the large crowd in the Senate hearing room. "The burden would shift to the states to pick the costs."

Speakers were very concerned about how the cuts would affect Medicaid's program for home- and community-based services (HBCS) for disabled patients; the program provides assistance at home with bathing, dressing, and other activities of daily living.

The success of current HBCS programs "is evident in the reduction in institutional services," said Nancy Thaler, deputy secretary for developmental programs at the Pennsylvania Department of Human Services. "Fourteen states and the District of Columbia have no public institutions [for the disabled] at all. This is important because not only do people with disabilities want to live in the community, they have a much better quality of life and the cost of community services are considerably less." For example, "the average per-person cost of a public institution is over $265,000 a year while the average cost of HCBS services is about $43,000."

As a result, by cutting Medicaid funding for programs such as HCBS, federal and state governments "might [actually] end up spending more money," since many patients who don't have access to HCBS would end up in institutions, said H. Stephen Kaye, PhD, of the Institute for Health & Aging at the University of California San Francisco. "Aside from other things wrong with it, it's not a good strategy for saving money."

That's true for several reasons, Kaye told MedPage Today in an interview. "There are some people for whom it's more expensive in the community, but it's very few," he said. "Most people [cost less]. One reason is housing costs are not included in HCBS, whereas with a person in [an institution], you're reimbursing for housing and food. The other thing is, it's not cheap; even there are though not that many nurses or doctors, it's still a really expensive model of care."

And people should "disabuse themselves of any thoughts" that states will make up the difference once Medicaid funds are cut, said Thaler. "If states have to compensate for cuts, the waiting list will simply grow."

The importance of HBCS services should not be underestimated, according to Andrea LaVant, a teen program specialist with the Girl Scouts of the Nation's Capital. "I have a friend who, while otherwise independent, can't leave her house on days when no personal attendant comes [to assist her] because she requires help getting her shoes on," she said.

LaVant, who is herself disabled due to a neuromuscular condition, said the services she receives at home are vital to helping her maintain her own independence. "There are countless others who count on Medicaid to [help them] lead their lives ... I beg of you -- not only for myself but millions like me whose lives will be literally destroyed -- to save Medicaid."

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